RAMALLAH — The World Health Organization (WHO) has warned that unless the siege of Gaza is lifted and a political solution implemented, Gaza's badly damaged health system will go from very bad to worse.

Palestinians walk past the UNRWA office, where representatives of Palestinian refugee camps conduct a sit-in protest against the reduction of health services, educational and social development within several camps, at al-Wehdat Palestinian refugee camp in Amman August 26, 2009. REUTERS/Muhammad Hamed

The WHO released a report in July stating that since the end of the war in January, most of Gaza's health services have begun to function again. But it says the health system is struggling to deliver advanced and comprehensive medical care to Gaza's 1.5 million people.

"There are a number of factors contributing to the continuing degradation of Gaza's health system," says Gaza and West Bank WHO head Tony Laurence.

"The isolation of Gaza's health system by the siege; the inability of people and equipment to get in and out of the territory; and the damage inflicted on an already compromised system by Israel's Operation Cast Lead are adding up," Laurence told IPS.

During Israel's intensive three-week bombardment of the coastal strip hospitals and clinics were attacked, as were ambulances and their personnel. Electricity plants and fuel depots were hit.

Shortage of fuel and spare parts, and electricity cuts have prevented hospital equipment and back-up emergency generators from running properly.

Additionally, Israel is allowing in only limited amounts of medicine and other humanitarian aid. According to the WHO, about 20 percent of essential items were out of stock in July.

WHO stated that even when essential drugs are sent, the quantity, quality and variety were insufficient to meet needs. It warned that without urgent supply the number of items out of stock would rise to 140 by September.

Urgently needed medical equipment and most spare parts have been prevented from entering Gaza since Israel and Egypt imposed a near total siege in June 2007.

"We have hundreds of pieces of medical equipment that would be able to run efficiently but lack one spare part. We have been waiting for over a year for a spare part for our CT equipment but the Israelis have refused to allow it in," says Dr. Bassem Naem, Gaza's Health Minister.

"We waited several months for a catheterization piece to be allowed to enter Gaza, and when the Israelis finally let it through it was badly damaged during inspection by the Israelis and rendered useless," Naem told IPS.

"We now have to go through the same bureaucratic nightmare while we wait again for a new one to be allowed in, and as Gaza has only one center offering catheterization treatment this is affecting those with chronic heart problems," says Naem.

"We also have wireless radio communications for ambulances that are sitting in the offices of the Red Cross in Jerusalem. But the Israelis have prevented the organization from bringing those in too."

Dr. Abu Said Ahmed told IPS that cancer patients were also being adversely affected. "We are limited in the amount of chemotherapy we can offer. Most of our cancer patients need to go abroad for advanced treatment, but Israel is limiting the exit permits given to patients," says Ahmed.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) says the number of Palestinians allowed to cross the Erez Crossing in northern Gaza declined in July by 25 percent compared to June.

"Doctors, medical technicians and other health professionals are unable to leave Gaza to travel abroad to attend medical conferences, upgrade their skills and swap expertise with their international colleagues, something which is vital for all medical personnel to keep their skills up to date," Naem told IPS.

Ahmed also complained about bureaucratic delays that held up tons of medical aid donated from abroad for months at a time until it had expired. "Additionally Israel has confiscated financial donations for medical relief from abroad from reaching us," he says.

Hospitals and clinics which were damaged or destroyed during the war have been unable to repair damage or rebuild as most reconstruction material cannot be imported.

IPS saw a number of windows at Shifa Hospital, Gaza's biggest, covered with tape and plastic as there is no glass available to repair the windows.

But Palestinian mismanagement and infighting has also contributed to the medical fiasco.

"Internal mismanagement is a contributing factor to the decline in the quality of health services, in particular, the adequate operation and maintenance of medical equipment," says WHO's report.

Problems identified include a lack of inventory of medical equipment; a centralized procurement system based on rules and processes that are inefficient and obsolete, compounded by political divisions between Gaza and the West Bank, the report said.

Meanwhile, Gazans don't have access to sufficient quantities of clean drinking water. Over several decades Gaza's growing population has over-used the territory's underground aquifer, which has been unable to replenish itself due to drought amongst other factors.

The discharge of untreated sewage into Gaza's streams complemented by agricultural fertilizers means only 5-10 percent of water extracted from the aquifer meets WHO standards.

Gaza's waste systems have been unable to treat all sewerage due to limited fuel and a lack of spare parts.

Watery diarrhea as well as acute bloody diarrhea and viral hepatitis remain major causes of morbidity among the refugee population of the Gaza Strip.

Chronic poverty and unemployment has aggravated poor levels of nutrition, especially among the elderly, pregnant women and children. Anemia among children 9-12 months stood at over 60 percent in February 2009, says OCHA.